Obamacare – what patients are asking

As a practicing dentist I have a ringside seat to the healthcare industry. I get asked a lot of questions about the Affordable Care Act or Obamacare – and I thought I would share some of these questions and my take on them.

Since this law is so flawed should we just ditch it and start over?

I will be the first to admit this ambitious endeavor has some flaws. However, just like the launch of a new Microsoft operating system, a few updates and patches must be installed before it is really useful. We need to expect and appreciate the tweaks that will make this work well, not just quit when the going gets tough. Our country is way overdue for some meaningful reform, this is a real start.

What exactly is Obamacare?

Well, the Affordable Care Act is really more insurance reform and regulation than it is a government-run health plan.

Why do we need it? The insurance industry has run amok. Companies have been giving shareholders and CEO’s huge payouts, spending huge sums on high-rise buildings and naming rights for stadiums. Yet at the same time, they are reducing benefits for patients and reimbursements for doctors and hospitals while still increasing premiums. The insurance industry has partially caused our healthcare crisis.

By implementing contracts that force providers to provide huge discounts to their members, they have caused the fees for the uninsured to skyrocket. Many of these contracts actually reimburse doctors and hospitals less than the cost to provide the care. The costs have shifted to the uninsured and to make it worse, thanks to insurance industry-sponsored legislation, it’s fraud to offer an uninsured patient a lower fee.

Reform is desperately needed.

What does it really do?

The Affordable Care Act brings capitalism back to the insurance industry. When individuals can pick and choose between policies there are better benefits, fewer loopholes and lower prices. Deep inside of the Affordable Care Act are provisions that mandate health insurers actually pay out healthcare benefits.

Why does the marketplace matter?

Historically, it has been very difficult for an individual to obtain health insurance either because they couldn’t qualify or couldn’t afford what they qualified for. Individuals without employer groups have no open enrollment. Meaning you have to apply and be underwritten to get insured. More often than not carriers simply would not write the policy. A member of my family was deemed uninsurable because they were in the “overweight” category. In the marketplace there is a health insurance option available to everyone. This would explain the ground swell of folks who just plain want to get insured (even if it doesn’t quite explain why the Web sites for enrollment failed with years to prepare).

Will it bankrupt the country?

No. The tax incentives and credits for individuals to purchase their own insurance are small compared to the number of Americans who declare bankruptcy each year because of unpaid health care bills. It’s actually good for the economy.

Will this harm the insurance companies?

No, they are actually in favor of this because it means they will sell more insurance.

What about employer mandates?

Employers who provide insurance options get incentives, employers of 50 more people who do not offer options get penalized. For employers who historically never offered any sort of payroll deduction coverage there are easy set up plans to affordably meet the requirement. It does not say employers have to pay the entire plan, nor does it say what benefits you have to offer. The incentives are significant. I may be going out on a limb here but I suspect the employers who are claiming to have to cut employees because of this were going to do it anyway. It’s easier to reduce your workforce when you can place the blame elsewhere.

Why the political bru-haha?

A wise man once told me never to discuss politics with my patients. I’ll let everyone else fill in the blank here.

Is Uncle Sam going to be writing prescriptions?

This may be my favorite question, as the Affordable Care Act does not actually provide public healthcare. Instead it helps make private healthcare more affordable for more people.

While it’s easy to see how emotional the country has become about certain facets of the Affordable Care Act, it’s important to take a step back and look at the big picture. There are pieces of the act that are not exactly friendly to dentistry and other pieces that are. We need to be open to modifying the legislation as it matures without the angst and animosity that have paralyzed our government and in the end hurt each one of us.

Dr. Stephanie McGann is a resident of the Unionville area and along with her partner, Dr. Marie Scott, operates The Brandywine Smile Center, a family-friendly dental practice in Concordville. She is a Fellow of the Academy of General Dentistry.